Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Monday, October 26, 2009

Paved by Good Intentions

"After this shift, I will have worked 105 hours this week."

"Why is that?" I asked.

"Because unlike the emergency room, where care is transfered easily to guys arriving at the next shift, hospitalists don't have that luxury. We have to stick with our patients once they're ours.

Let's say it's quarter to five. The nocturnist comes on at six. The call comes from the ER and you get a guy that's sick as hell: something like an aortic dissection with crappy renal function that's too sick for surgery. He's never been in our system. No history. No real physical. The family doesn't know his medications. The ER only provides a listing - no doses - I have to call their home and get the list or wait for them to bring in the bottles, review the labs, order a slew more tests. I can't just offload the case to the evening nocturist at six - he's got his own ER admissions he has to see. Meanwhile, I still haven't written notes from seven other patients I've seen that day and have a slew of phone calls and results that I have to review. I can't just offload that to someone else..."

I give this great hospitalist about another month.

Good care takes time. Family social challenges, missing patient information, higher levels of disease severity and anxiety over patient's well-being add to physician stress. As larger number of patients are pushed through the system in shorter periods of time, physician burnout - even in the hospitalists "shift model" - remains a significant problem today.

11 comments:

It's interesting to see if from your point of view. I work in the ER, and like you said, it is very easy to transfer care. While you say that can't offload it to the next guy, I have seen it done plenty of times. Or, we will call and the consulting doctor will ask if we could wait 15 minutes to call the next guy. Oh well. It is what it is.

On another note, since you are a cardiologist, I am a nursing student trying to learn EKGs, do you have a good website I can look at for the normal times? Thanks!

I presume there are plenty of other jobs out there for this hospitalist if he finds the hours too taxing. Oh, wait! We are in the middle of a major recession and there really are not that many jobs out there!

I just was talking to my brother who is constantly on call for the company he works for as a tech consultant. There are few high paying jobs in his field and if you whine about the hours, then there are a bevy of well trained Indians waiting to take your job. Also a patient told me how he put out an add for a Phd trained mathematician for 12.50/hour on Craigs list and got 7 hits within a short time. And finally, I was just over in Michigan. You think things are bad here!

Oh, by the way; I am having trouble doing the math again on this one. This poor hopspitalist has worked 105 hours in a week, but there are plenty of hospitalist programs where they work 40-50 hour weeks, which means he would have to be averaging 15 hours per day for 7 days a week. Many programs have a more intense week on where you are working 12 hour shifts for several days, but then you would get the following week off! (your hospitalist might not have mentioned this to you). This means with all his extra effort, he may not really be working that many hours total per week average.

I presume there are plenty of other jobs out there for this hospitalist if he finds the hours too taxing. Oh, wait! We are in the middle of a major recession and there really are not that many jobs out there!

Interesting comment. I am constantly amazed at your smugness regarding this rationale that doctors will stay where they are, even with looming patient care crunches and worksplace stressors increasing. Recall that it costs a health care system significantly to replace their staff. Even if he goes elsewhere - who wins? The doctor? The patients for whom he was doing a great job?

No, in your rationale it will be a foreign medical graduate who benefits since he should "just get over it" and stop whining.

It is a global economy after all.I think it is just the reality that after you invesst all that time in training, what other occupation will you perform? Become a hedge fund manager?

Medical schools still fill all their slots with more begging to get in. FMGs will continue to fill those slots in residency that don't get filled. Why? Because doctors here still make more than anywhere else in the world!

My point was that many previously high paying occupations are now having the same pricing or work hour pressures. This is not unique to medicine.

From my perspective, I think there are alot of people out there that are in worse shape than us doctors, and it is not great PR for the medical profession to continue to gripe about our pay and hours given the current economic conditions.

"From my perspective, I think there are alot of people out there that are in worse shape than us doctors, and it is not great PR for the medical profession to continue to gripe about our pay and hours given the current economic conditions."

The point is not to gripe, but rather point out that shift work may not be the panacea that some envisioned when it comes to providing quality care to our patients.

Quite frankly, I don't see it as griping - rather, it's putting the reality of a doctor's schedule out there since few who are not in the medical field truly understand the hours in versus the pay out.

I have folks tell me all the time how lucky I am being married to a doctor - yes, I love him; yes, I can't imagine my life without him; and yes, I know I won't see him for good ten more years since he's working insane hours!

As a solo specialist in a small community, he clocks no less than 90 hours a week - 65 office hours, Monday-Saturady, with an addition 8-hours a week for two Sundays....and that's not counting time before and after office hours to do dictation, chase reimbursements with insurance companies, doing more detailed records to resubmit a denied claim - that all adding another 15-20 hours a week....oh and he's on call 24/7....he takes one week a year vacation, five days for his annual conference - that's IT....oh and let's not forget his hospital requires 50 CME a year to maintain privleges, another hour a week!

How much should he be paid for the equivalent of 2 full-time jobs + another part-time 10 hours each week?

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.